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Updated August 19, 2019
SERIOUS MENTAL ILLNESS (SMI) PORTAL
USER MANUAL
Updated August 19, 2019 Page 2 of 23
Client Information Systems File Layout and Specifications Manual
v.1
Section 1
SMI Determination Process Effective October 01, 2017
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Serious Mental Illness (SMI) Portal User Manual
Table of Contents
ABH SMI Portal .............................................................................................................................................. 4
Accessing the Portal .................................................................................................................................. 4
Initiating a New Case................................................................................................................................. 5
Proceeding without Member ID ............................................................................................................... 7
Entering Determination Information ...................................................................................................... 14
Submitting a Case.................................................................................................................................... 15
Opening a Submitted Case ...................................................................................................................... 16
Field Definitions and Rules ...................................................................................................................... 16
Web‐Based Reports .................................................................................................................................... 19
Post‐Submission Processing ........................................................................................................................ 19
Daily Status Files ......................................................................................................................................... 20
Open SMI Pended Eligible Report ........................................................................................................... 20
Open SMI Pended Non‐Eligible Report ................................................................................................... 20
SMI Determination Outcome Eligible Report ......................................................................................... 21
SMI Determination Outcome Non‐Eligible Report………………………………………………………………………………22
T/RBHA Responsibilities .............................................................................................................................. 23
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Serious Mental Illness (SMI) Portal User Manual
ABH SMI Portal
SMI Determinations are entered into a secure web-based portal by the third-party SMI vendor for processing. This portal is maintained and administered by Arizona Health Care Cost Containment System (AHCCCS). The following sections of this document serve as a guide for data entry into the SMI Portal by the third-party SMI vendor, including the rules and logic edits incorporated into the Portal necessary to ensure an acceptable level of data integrity.
Accessing the Portal
The SMI Portal is located at https://abhportal.azahcccs.gov. All users must first register and be approved by AHCCCS prior to accessing this site (select “Register” on the top left of the screen to proceed). Users will receive an email notification from AHCCCS once their request has been approved and finalized.
After registration, users are to review and agree to the above terms, and then supply their unique username and password, prior to accessing the Portal.
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Serious Mental Illness (SMI) Portal User Manual
The main screen of the ABH Portal is displayed on the following page. All users granted access to the SMI portal are also permitted limited rights to the Client Information System (CIS) member eligibility look-up tool; these applications are accessible from the banner at the top of the screen. This is necessary to complete the full SMI Determination process, beginning with member identification and continuing through any potential appeal of the decision.
Initiating a New Case
Once the SMI vendor receives a referral for determination from a provider they are to access the SMI Portal and initiate a case for that request. The user will select “SMI” from the main screen (above) to begin this process.
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Serious Mental Illness (SMI) Portal User Manual
“Search by Client Information” uses seven possible combinations of search criteria to help find the appropriate member. Listed below are seven different combinations available to search:
1. AHCCCS ID and Date of birth
2. Last name, Date of birth and Social security number
3. AHCCCS ID, Last name and Date of birth
4. AHCCCS ID, Last name, First Name and Date of birth
5. Last name, First name and Date of birth
6. Last name, First name, Date of birth and Social security number
7. Alternate ID (Client ID) and Date of birth
Note: Lower part of the search screen will change according to option user chose.
Below the Search Fields there are two buttons that are used for executing the search (Search) and clearing the fields and search results (Clear). Almost all fields shown in the Search fields form are required, and this is indicated by asterisk (*).
If search is executed, and any of the fields are left empty or with a wrong format, process will display on the screen list of the errors, indicating problems found.
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Serious Mental Illness (SMI) Portal User Manual
After entering members data in the search form, if one is not found in PMMIS using available information on that person, the following message appears “NO RECORDS FOUND !!!” an additional link will be displayed with the text “Continue without AHCCCS ID” to allow user to proceed to the next step.
Proceeding without Member ID
In case member is not found, additional link “Contact AHCCCS-DHCM” is displayed below the search portion of the screen to allow sending email message to AHCCCS DHCM in order to facilitate necessary follow-up. Clicking on the link will bring up modal pop-up containing search fields prepopulated with current search criteria, allowing user to type any information that may help in further search process.
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Serious Mental Illness (SMI) Portal User Manual
Both of the search paths may return one or multiple members. In this case, search results are displayed below the Search Fields in the separate table under “CLIENT INFORMATION”. Table contains some additional fields, so the user can confirm and choose the correct one by clicking on the “Select” link in the first column of the table.
After filling out form and submitting, a new record will be created in the SMI/CIS system with a missing AHCCCS ID. These Cases will be in “PENDING” status and will not be sent to PMMIS for evening processing, as that process will not include Cases without AHCCCS ID.
An email with all submitted information will be sent to AHCCCS-DHCM (Lori Petre and David Rudnick) for further research.
After research, AHCCCS-DHCM team may come to two conclusions:
1. Member exists in the PMMIS system, personal data is not correct.
In this instance SMI VENDOR will be informed about findings and member information including AHCCCS ID will be communicated to them.
On the Report page of the CIS SMI portal, under the link “View cases open or submitted with no id” where Cases are listed with missing AHCCCS ID, SMI VENDOR will be able to add a Case by selecting appropriate one and clicking on the button “Add missing AHCCCS ID” located on the “CASE DETAILS” form.
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Serious Mental Illness (SMI) Portal User Manual
That process will automatically request all necessary member information from PMMIS and update SMI/CIS system. Updated record will be sent to the PMMIS in the next evening cycle.
2. Member does not exist in PMMIS and requested T/RBHA or Health Plan will be informed to undertake all necessary steps to add member to PMMIS system.
For these instances, a new daily process will be established to retry matching Cases in the “PENDING” status and missing AHCCCS ID with PMMIS data. If member is found, record will be updated with the returned AHCCCS ID and other necessary information, and will be sent to PMMIS in the next evening cycle.
All Cases having “PENDING” status will be outdated and removed from the CIS SMI system after 90 days of their SMI VENDOR submission date.
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Serious Mental Illness (SMI) Portal User Manual
Selecting the member will then make another inquiry about member enrollment/eligibility data, displaying it together with some general member data on the page with a form to enter/update evaluation record.
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Serious Mental Illness (SMI) Portal User Manual
In cases when member does not have ABH enrollment, it will not have Client ID assigned, and one will not be created for the purpose of recording SMI evaluation. To allow submission without acquiring Client ID, Health plan dropdown is prepopulated with a record found in the current member behavioral services enrollment segment. This value is also used to determine where evaluation packages and reports will be sent in the further processing.
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Serious Mental Illness (SMI) Portal User Manual
The member’s identifying information will be displayed at the top of the page, as seen in the preceding image. A new case requires two pieces of data to be initiated – those being the “Date [SMI Vendor] Received Determination Packet” and the “Referral Source”, which are located in the section titled “Pre- Determination Information”.
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Serious Mental Illness (SMI) Portal User Manual
Other is located on the Reports page, under “View Case Submitted” section.
Process is initiated by simply choosing health plan from the Dropdown control and clicking button “Send Evaluation Packet”.
“Preferred Clinic” field is changed to show dropdown allowing user to choose from a list of sites. If the chosen Health plan is T/RBHA and a text box appears, this will allow user to type in preferred site. If Health plan is not a T/RBHA, there will be no values in the lookup table.
In case Health plan field is left blank, SMI evaluation will still be submitted to PMMIS, but determination packages will not be sent. Only way to send packages, will be by using Internal SMI part of the application. For that purpose, on two different pages that displays detailed evaluation records, Dropdown – Button combination is added to the user interface. One is located on the Home page that appears after searching for the client information. If the chosen Health Plan is different from the one we got in the open ABH enrollment segment, evaluation package will be sent to both parties.
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Serious Mental Illness (SMI) Portal User Manual
Entering Determination Information
Once the case has been initiated, the SMI Vendor may complete the evaluation review process and enter the required information (notated by an ‘*’) into the portal for completion. The Portal is divided into four distinct sections:
Pre-Determination Information; Pend or Extension Status; Determination Results, and; Member Assignment
There is also a section at the bottom where any case-specific notations can be added. This is a free text field.
The SMI Vendor may update the various case sections as the data becomes available and progress may be saved by selecting “Update” at the bottom of the screen. However, the case may not be submitted until all required fields are populated with valid information (see rules, pages 17‐19).
Pre-Determination Information:
The Pre-Determination section is designed to capture information largely focused on the activities that occurred prior to the SMI Vendor receiving the evaluation packet. This information is critical for monitoring and assessing the timeliness of the evaluation and determination process.
1 Not all fields will be populated in instances where the member in question has no SMI or AHCCCS ID
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Serious Mental Illness (SMI) Portal User Manual
Pend or Extension Status:
Information in this section is not required for successful submission – as not all cases will pend or need an extension. However - should the case in question require a 20 or 90-day pend, or an extension, and this has been approved by the member and documented in the file, this must be entered into this section of the Portal. This allows the Department, as well as the SMI vendor, to account for cases that were not successfully completed and submitted within the required timeframes.
Determination Results:
This section includes all pertinent data elements that substantiate the SMI Vendor’s conclusion as to the member’s SMI status. The vendor must populate all fields marked with an asterisk (*) upon completion of the review process in order to finalize the submission. This includes the determination date, determination result, reason for any denial, diagnoses and functional score, as well as the names of the individuals who performed the SMI assessment and the reviewing BHMP.
Member Assignment:
During the SMI evaluation process, and prior to determination review, the member is asked which SMI clinic they would like to be assigned to if they are subsequently determined SMI. This preferred clinic should be chosen from the drop down list, the SMI portal will automatically display that clinic’s street address. Additionally, the SMI vendor should include why that clinic was selected by the member, for example, the geographic location, or familiarity with said provider agency. The T/RBHA will use this preference when assigning the member to their primary clinic if they are determined SMI.
Submitting a Case
Once all required documentation has been entered into the SMI Portal the case can be submitted to AHCCCS for processing. This is done by selecting “Submit Case” at the bottom of the data entry screen. The Portal performs a series of pre-submission logic edits that prevent the user from entering invalid or illogical data into SMI. The user will receive notification should any field flag an error – this must be corrected prior to submission. Once the record is validated, the user will receive a prompt indicating that the case is about to be submitted and will no longer be available for editing.
The user will then be instructed to attach the evaluation packet. The evaluation material must be provided in one file and is not to exceed 10MB. AHCCCS will rename this file to include the case ID and submittal date, and subsequently forward this file to the T/RBHA for the clinic’s records.
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Serious Mental Illness (SMI) Portal User Manual
Opening a Submitted Case
As noted in the preceding section, once a case is submitted to AHCCCS it is locked to prevent any accidental or inadvertent changes to the record. However, in certain circumstances it may be necessary to reopen and change the determination finding, or other information, within a previously submitted case. This is most commonly attributed to cases that are overturned after an appeal. In order to safeguard this process, only select individuals at AHCCCS and the SMI Vendor are permitted to reopen a case. Users with this privilege may search the Portal by case ID (main screen) and then select “Open Case” at the bottom of the data entry screen. They will then be allowed to make any needed changes and resubmit the case to AHCCCS.
Field Definitions and Rules
Field Title
Definition
Allowable Options
Edits / Rules
Required to
Submit Case ID Unique Record ID NA System Generated
Received Date
The initial date the SMI Vendor received the SMI Determination Packet for review
MM/DD/YYYY
Must be less than or equal to system date
Yes
Referral Source
Name of Evaluating Provider submitting SMI Determination Packet for review
Free Text
Character Limited
Yes
Evaluation Request Date
Date the SMI Evaluation Request was Received by the Evaluating Provider
MM/DD/YYYY Must be less than or equal
to Received Date
Yes
Evaluation Request Time
Time the SMI Evaluation Request was Received Evaluating Provider
(HH:MM)
Required if Inpatient Status is ‘Yes’
Yes if Inpatient Status is ‘Yes’
Evaluation Date
Date the Evaluating Provider completed the SMI Evaluation Assessment
MM/DD/YYYY
Must be less than or equal to Received Date
Yes
Evaluation Time
Time the Evaluating Provider completed the SMI Evaluation Assessment
(HH:MM)
Required if Inpatient Status is ‘Yes’
Yes if Inpatient Status is ‘Yes’
Inpatient Status
Was Member Inpatient During Time of Evaluation Request?
Drop Down (Yes/No)
None
Yes
Pended Status
The length of time the selected case's determination has been pended
Null
Must be Null if case is not pended; Pended Status Date and Reason must be Null
No
20‐day
Pended Status Date and Pend Status Reason cannot be Null
No
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Serious Mental Illness (SMI) Portal User Manual
Field Title
Definition
Allowable Options
Edits / Rules
Required to
Submit
90‐day Pended Status Date and Pend Status Reason cannot be Null
No
Pended Status Date
Date the selected case was placed in pended status
MM/DD/YYYY
Default to Null if Pended Status is Null; must be greater than or equal to Received Date; cannot be greater than system date
Yes ‐ if Pended Status is Not Null
Pended Status Reason
Reason selected case was pended
Null
Default to Null if Pended Status is Null; cannot be Null if Pended Status is populated
Yes ‐ if Pended Status is Not Null
Need Additional Information/ Records NA
Need for Further Evaluation NA
Substance Abuse evaluation/ abstinence NA
Date of Extension Request
Date the Individual agreed to an extension in determining their SMI status
MM/DD/YYYY
Must be greater than or equal to Received Date; cannot be greater than system date
No
Extension End Date
Date the extension ended MM/DD/YYYY Default to Null No
SMI Eligibility Determination
Result (Finding) of Vendor's review of SMI Determination Packet
SMI
1) At least one of the Diagnosis (DX) Code (CD) disorders must equate to an SMI‐approved diagnosis.
Yes
Not SMI
1) No DX CD disorders equate to an SMI‐approved diagnosis ‐ GAF Score greater than 50
Withdrawn
SMI Determination Date must be populated; DX CD, GAF Score, Assessor and BHMP Names, License Type can be Null
Reason for SMI Eligibility Denial
Reason the member was not Determined to be SMI
Null
Default to Null if SMI Eligibility Determination is 'SMI' or ‘Withdrawn’
Yes if SMI Eligibility equals Not‐SMI
Individual Does not Meet Functional Requirements
GAF Score must be greater than 50
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Serious Mental Illness (SMI) Portal User Manual
Field Title
Definition
Allowable Options
Edits / Rules
Required to
Submit Individual does not
meet Diagnosis Qualifications
No DX CD disorders equate to an SMI‐approved diagnosis
Individual Does not Meet Either Functional or Diagnosis Requirements
GAF Score must be greater than 50 ‐AND ‐ No DX CD disorders equate to an SMI‐approved diagnosis
SMI Determination Date
Date the SMI Determination for the selected case was completed
MM/DD/YYYY
Must be greater than or equal to Received Date; cannot be greater than system date; If SMI Eligibility Determination equals “Withdrawn”, this field must reflect the date the request for determination was withdrawn.
Yes
Diagnosis CD 1 ‐ 7
Developmental and Personality Disorders
DSM‐IV‐TR format
Per policy, at least one of the DX CD disorders must equate to an SMI‐approved diagnosis if SMI Eligibility Determination equals 'SMI'
DX CD1 Yes; all others required
if supplied
by provider
Global Assessment of Functioning (GAF) Score
Member's level of functioning
0‐100 point scale
Yes
First Name of Person who Conducted SMI Assessment
Free Text
Free Text
Character Limited
Yes
Last Name of Person who Conducted SMI Assessment
Free Text
Free Text
Character Limited
Yes
First Name of Behavioral Health Medical Practitioner
Free Text
Free Text
Character Limited
Yes
Last Name of Behavioral Health Medical Practitioner
Free Text
Free Text
Character Limited
Yes
License BHMP / BMP Drop Down Yes
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Serious Mental Illness (SMI) Portal User Manual
Web-Based Reports
The SMI Portal has an integrated reporting feature which permits users to readily review the status of current and historical determination cases, including:
Cases Open, not yet Submitted to AHCCCS Cases Submitted to AHCCCS Cases Open or Submitted with no SMI ID
This feature is accessed by selecting “Report” at the top of the Portal’s member/case search screen.
Post-Submission Processing
Once the SMI Vendor has completed the determination and submitted the case to AHCCCS, the record status is updated to ‘Submitted’ and staged for enrollment processing via the nightly Change File generation package.
Furthermore, the nightly process will review all cases submitted for members with no AHCCCS ID and append the ID(s) to the record if found in SMI Portal. The system must first match 100% of the member’s identifying information prior to appending an ID to the record. Once completed, the case record is then reviewed against the above rules and processed appropriately.
All records submitted to the SMI Portal are reviewed for the above criteria every night and processed accordingly.
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Serious Mental Illness (SMI) Portal User Manual
Daily Status Files
AHCCCS produces four status reports that occurs every night Monday through Friday and provides these files to the SMI Vendor.
1. Open SMI Pended Eligible Report(All MCOs) (Open-SMI-Pended-Elig-Report_yyyymmdd_######(health plan ID).DAT)– daily summary of all submitted records where the SMI status of an eligible member is under evaluation by CRN, but still not submitted to PMMIS.
2. Open SMI Pended Non-Eligible Report(RHBA Plans Only) (Open-SMI-Pended_NonElig-Report_yyyymmdd_######(health plan ID).DAT)– daily summary of all submitted records where the SMI status of non-eligible member is under evaluation by CRN, but still not submitted to PMMIS.
3. SMI Determination Outcome Eligible Report(All MCOs)
(SMI-Determination-Outcome-Elig-Report_yyyymmdd_######(health plan ID).DAT) – daily summary of all records submitted by CRN to AHCCCS to indicate the final SMI status of an eligible member,
4. SMI Determination Outcome Non-Eligible Report(RBHA Plans Only)
(SMI-Determination-Outcome-Non-Elig-Report_yyyymmdd_######(health plan ID).DAT) – daily summary of all records submitted by CRN to AHCCCS to indicate the final SMI status of non-eligible member,
Open‐SMI‐Pended‐Elig‐Report_{yyyymmdd}_{health_plan_id}.DAT file layout
Field Name Size Record Position From To
Case Id 10 1 10
Client Id 10 11 20
AHCCCS Id 9 21 29
Last Name 20 30 49
First Name 20 50 69
Record Creation Date (YYYYMMDD) 8 70 77
Days between Current Date and Record Creation Date
4 78 81
Evaluator First Name 10 82 91
Evaluator Last Name 20 92 111
Record Creation Info 30 112 141
Decertification 1 142 142
Open‐SMI‐Pended‐NonElig‐Report_{yyyymmdd}_{health_plan_id}.DAT file layout
Field Name Size Record Position From To
Case Id 10 1 10
Client Id 10 11 20
AHCCCS Id 9 21 29
Last Name 20 30 49
First Name 20 50 69
Record Creation Date (YYYYMMDD) 8 70 77
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Serious Mental Illness (SMI) Portal User Manual
Days between Current Date and Record Creation Date
4 78 81
Evaluator First Name 10 82 91
Evaluator Last Name 20 92 111
Record Creation Info 30 112 141
Decertification 1 142 142
SMI‐Determination‐Outcome‐Elig‐Report_{yyyymmdd}_{health_plan_id}.DAT file layout
Field Name Size Record Position From To
Case Id 10 1 10
RBHA Id 2 11 12
Client Id 10 13 22
AHCCCS Id 9 23 31
Last Name 20 32 51
First Name 20 52 71
Date Of Birth (YYYYMMDD) 8 72 79
Referral Source 30 80 109
Record Evaluation Date (YYYYMMDD) 8 110 117
SMI Eligibility Determination 1 118 118
SMI Denial Reason 1=(N/A ‐ eligibility determination is SMI) 2=Individual Does Not Meet Diagnosis Qualifications 3=Individual Does Not Meet Functional Requirements 4=Individual Does Not Meet Either Functional or Diagnosis Requirements
1 119 119
Review Decision Date (YYYYMMDD) 8 120 127
Diagnosis CD 1 8 128 135
Diagnosis CD 2 8 136 143
Diagnosis CD 3 8 144 151
Diagnosis CD 4 8 152 159
Diagnosis CD 5 8 160 167
Diagnosis CD 6 8 168 175
Diagnosis CD 7 8 176 183
Evaluator First Name 10 184 193
Evaluator Last Name 20 194 213
Decision Taker First Name 10 214 223
Decision Taker Last Name 20 224 243
EOC Start Date (YYYYMMDD) 8 244 251
Demographics ECN 15 252 266
Days between Record Creation Date and Record Change Date
4 267 270
OGA Appeal 1 271 271
Site Description 35 272 306
Site Choice 35 307 341
Decertification 1 342 342
Inpatient State 1 343 343
Request Received Date (YYYYMMDD) 8 344 351
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Serious Mental Illness (SMI) Portal User Manual
Request Received Time 8 352 359
Request Completed Time 8 360 367
Days between Record Evaluation Date and Request Received Date
4 368 371
Referral Date (YYYYMMDD) 8 372 379
SMI‐Determination‐Outcome‐NonElig‐Report_{yyyymmdd}_{health_plan_id}.DAT file layout
Field Name Size Record Position From To
Case Id 10 1 10
RBHA Id 2 11 12
Client Id 10 13 22
AHCCCS Id 9 23 31
Last Name 20 32 51
First Name 20 52 71
Date Of Birth (YYYYMMDD) 8 72 79
Referral Source 30 80 109
Record Evaluation Date (YYYYMMDD) 8 110 117
SMI Eligibility Determination 1 118 118
SMI Denial Reason 1=(N/A ‐ eligibility determination is SMI) 2=Individual Does Not Meet Diagnosis Qualifications 3=Individual Does Not Meet Functional Requirements 4=Individual Does Not Meet Either Functional or Diagnosis Requirements
1 119 119
Review Decision Date (YYYYMMDD) 8 120 127
Diagnosis CD 1 8 128 135
Diagnosis CD 2 8 136 143
Diagnosis CD 3 8 144 151
Diagnosis CD 4 8 152 159
Diagnosis CD 5 8 160 167
Diagnosis CD 6 8 168 175
Diagnosis CD 7 8 176 183
Evaluator First Name 10 184 193
Evaluator Last Name 20 194 213
Decision Taker First Name 10 214 223
Decision Taker Last Name 20 224 243
EOC Start Date (YYYYMMDD) 8 244 251
Demographics ECN 15 252 266
Days between Record Creation Date and Record Change Date
4 267 270
OGA Appeal 1 271 271
Site Description 35 272 306
Site Choice 35 307 341
Decertification 1 342 342
Inpatient State 1 343 343
Request Received Date (YYYYMMDD) 8 344 351
Request Received Time 8 352 359
Request Completed Time 8 360 367
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Serious Mental Illness (SMI) Portal User Manual
T/RBHA Responsibilities
Once a case has been submitted to the SMI Portal the T/RBHA is responsible for ensuring that the member’s status in SMI Portal and PMMIS is appropriately updated. Additionally, if the member is non-Medicaid eligible, the T/RBHA must transmit an 834 enrollment add or change record to AHCCCS with the correct mental health category documented.
Days between Record Evaluation Date and Request Received Date
4 368 371
Referral Date (YYYYMMDD) 8 372 379